The detection of Kaposi’s sarcoma-associated herpesvirus (KSHV) DNA in blood, together with increased antibody titres, suggests KSHV reactivation, with transmission of KSHV occurring via viral shedding in saliva. The authors were interested in the risk factors for KSHV DNA detection by real-time PCR in blood, and viral shedding in saliva, in 878 people aged 3–89 years in a rural Ugandan population cohort. KSHV viral load in blood was not found to correlate with viral load in saliva, suggesting separate immunological control within each compartment. The proportion of patients with detectable virus in blood was 23% among children aged 3-5 years, 22% in 6-12 year olds, and then reducing with increasing age. The proportion of patients with detectable virus in saliva increased from 30% in 3-5 year olds to 45% in those aged 6-12 years, and then decreasing with increasing age. Overall, 29% of males shed in saliva compared with 19% of females. Therefore young males may be responsible for much of the onward transmission of KSHV. Patients currently infected with malaria had significantly higher levels of viral DNA in their blood compared with malaria-uninfected patients. Therefore malaria may lead to KSHV reactivation, increasing the transmission and pathogenicity of the virus.
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